As a physician who has focused on women's sexual health for decades, I've found that pelvic floor muscles routinely begin to weaken by age 40. Yet, while many women focus on their weight and exercise regularly, they often forget to exercise this incredibly important set of muscles! So what can we do to make sure we don't end up with incontinence pads or needing surgery? Here are nine things that you need to know about your pelvic floor muscles:

1. Your pelvic floor muscles need preventive care.

We have this beautiful diamond-shaped group of muscles within our pelvic floor that act as a sling to support our internal organs, keeping everything separate and working together. Your pelvic floor muscles provide optimum support to your bladder, vagina, and uterus. Over time, we inevitably experience weakening in these muscles. And if we don't take action to prevent this weakening from happening we can start to experience tinkling at the most inconvenient times!

As we get older, many of us experience incontinence issues. We sneeze, we cough, we're doing an exercise…and oops, there it is. The embarrassing leak. In fact, the No. 1 reason elderly women end up in nursing homes has been attributed to incontinence issues. The key is prevention, so women need to be protective of these important muscles! And starting early is best.

2. It's all about those sex hormones, baby.

Women's sex hormones naturally start to decline as they age, even prior to menopause. And these hormones—which include estrogen, progesterone, testosterone, and dehydroepiandrosterone (DHEA)—maintain the health and integrity of the vaginal lining and surrounding muscles. As our hormone levels naturally decline we can experience vaginal dryness, thinning of the lining, irritations, discharge, and discomfort; many women also experience pain during intercourse. And pelvic floor muscle loss also occurs, bringing with it issues like urinary leakage and prolapse. But don't worry, just like we can exercise to get rid of the flab on our arms—or to strengthen other parts of our body—we can exercise and take care of our lady parts, too.

Article continues below

3. Women need to exercise their pelvic floor muscles no matter what their age.

It's worth mentioning that all women over the age of 30 should be protective of their pelvic floor muscles! The key is prevention, so you don't end up with incontinence issues or pelvic prolapse problems (this is when your uterus, rectum, urethra, or bladder starts to collapse into your vagina). Pregnancies, improperly done exercises (from squats or Pilates, for instance) as well as living a sedentary life (we all do too much sitting!) all affect our pelvic floor muscles.

Unfortunately, many of us accept a little leakage here and there and just live with it. We run out and buy one of the new incontinence products in the women's sanitary products aisle: There are so many, with new ones coming out each day! There are heavy-duty liners, panties, and even tampon-like plugs just for incontinence issues. The number of prescription options for incontinence symptoms has also been on the rise—not to mention the number of incontinence-related and prolapse surgeries.

4. The pelvic floor muscles are not just about sex.

It's true that healthy pelvic floor muscles can help you have stronger orgasms, but for those of you who may be saying, "I'm not having sex, so this doesn't apply to me," think again! Having healthy pelvic floor muscles is vital for women to live a pain-free and healthy life—regardless of their sexual activity. I mean, who wants embarrassing leakage? Even more, who wants to experience pelvic prolapse issues that cause pain and may even require surgery?

5. Kegels are not the only way to strengthen these muscles.

Using Kegels to exercise your pelvic floor muscles is key, but there are also other lifestyle changes you can make. Think about the weight you're carrying around and how that pushes down on your pelvic floor muscles. Obesity and other chronic conditions such as diabetes can all contribute to worsening symptoms. I always recommend that women try to sit less and incorporate more exercise into their daily routine, plus, I'm a big fan of the ketogenic diet for maintaining a healthy weight. If you're a smoker, your pelvic health is yet another reason to stop! All of that coughing creates additional abdominal pressure.

Article continues below

6. Many women are doing their Kegel exercises incorrectly.

Yes, it's true! And I can tell you that it's more likely "most" women. I have had hundreds of patients tell me that they have, in fact, done their Kegel exercises faithfully but continue to have issues. Usually, we uncover that they've been doing them incorrectly.

After I created a video on how to do the perfect Kegel exercise, I had a client who was 72 years old and she said, "I've had struggles with prolapse. I watched your video and I figured out that I was doing these pelvic exercises wrong all these years." She started working on them in the proper way and it made a tremendous difference. Eventually, she could feel the strength of her pelvic floor and didn't experience the pressure at the end of the day that she used to feel. The take home message here? We can improve the strength of our pelvic floor at any age!

Let's be clear, if you don't keep your pelvic floor muscles strong and healthy, they won't be able to provide long-term support for your vagina, bladder, and uterus. And you may find yourself experiencing greater issues. Many women have also said that their leakage issues interfere with their desire to have sex and that it has affected their self-esteem and created "sexual distress." Many of my patients have also told me that their urine leakage actually stopped them from doing the things that they loved like biking, horseback riding, or playing sports. And that is just crazy sad!

8. There are so many benefits to having healthy pelvic floor muscles.

Wouldn't it be great to live your life and do the things you want to do without worry? When you have a strong pelvic floor you'll also have healthy blood vessels, blood flow, and nerve supply to your vital pelvic tissues—no to mention increased confidence and self-esteem because you can laugh, cough, or sneeze without urinary leakage.

Article continues below

9. Digestion also plays a part.

When it comes to supporting your pelvic floor, digestion is also important. Constantly straining, having gas, or chronically clenching can really affect your muscles. I often recommend women get checked for food intolerances that could be triggering an inflammatory response and affect the pelvic musculature and surrounding tissue. Dairy and gluten are often prime suspects. Try an elimination diet, and you might find that it easily resolves some of your pelvic pain or urinary leakage symptoms.